Provider Demographics
NPI:1134689607
Name:BITTLE, JESSE (CPED)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:BITTLE
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 HACIENDA DR STE 5
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-4544
Mailing Address - Country:US
Mailing Address - Phone:760-598-3668
Mailing Address - Fax:760-266-5603
Practice Address - Street 1:1830 HACIENDA DR STE 5
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-4544
Practice Address - Country:US
Practice Address - Phone:760-598-3668
Practice Address - Fax:760-266-5603
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPED1717224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist